R. Stovall, Internal Medicine Resident, MD, Boston University Medical Center, Boston, Massachusetts.
C. Peloquin, Statistical Manager, MPH, D. Felson, Professor of Medicine and Epidemiology, MD, MPH, T. Neogi, Professor of Medicine, MD, PhD, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts.
J Rheumatol. 2021 Jul;48(7):1007-1013. doi: 10.3899/jrheum.200453. Epub 2021 Jan 15.
Ankylosing spondylitis (AS) and psoriatic arthritis (PsA) often affect the hip and/or knee. If effective, treatments might reduce risk of total hip or total knee arthroplasty (THA/TKA). We evaluated risk of THA/TKA related to use of medical therapies in AS/PsA.
We conducted a nested case-control study using 1994-2018 data from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims, laboratory results, and enrollment records for commercial and Medicare Advantage enrollees. Among those with AS/PsA, THA/TKA cases were matched up to 4 controls by sex, age, AS/PsA diagnosis, diagnosis year, insurance type, obesity, and prior THA/TKA. We assessed AS/PsA treatment 6 months prior to THA/TKA, including disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi), alone or in combination, stratified by nonsteroidal antiinflammatory drug (NSAID) use. We evaluated the relation of treatment to risk of THA/TKA using conditional logistical regression with adjustment for confounders.
Among 16,748 adults with AS, there were 444 THA/TKA cases and 1613 matched controls. Among 34,512 adults with PsA, there were 1003 cases and 3793 controls. Adjusted ORs for treatment category and THA/TKA ranged from 0.60 to 1.92; however, none were statistically significant. Results were similarly null in several sensitivity analyses.
Odds of THA/TKA were not reduced with any combinations of NSAIDs, DMARDs, or TNFi among persons with AS or PsA. Given current utilization patterns in this population of US adults with AS and PsA, these medical therapies did not appear to be associated with less end-stage peripheral joint damage.
强直性脊柱炎（AS）和银屑病关节炎（PsA）常累及髋关节和/或膝关节。如果有效，这些治疗方法可能会降低全髋关节或全膝关节置换术（THA/TKA）的风险。我们评估了 AS/PsA 患者使用医学疗法与 THA/TKA 相关的风险。
我们使用 1994 年至 2018 年 OptumLabs 数据仓库中的数据进行了一项嵌套病例对照研究，该数据库包括去识别的医疗和药房索赔、实验室结果以及商业保险和医疗保险优势计划参保者的登记记录。在 AS/PsA 患者中，THA/TKA 病例与性别、年龄、AS/PsA 诊断、诊断年份、保险类型、肥胖和既往 THA/TKA 匹配了 4 名对照。我们评估了 THA/TKA 前 6 个月的 AS/PsA 治疗情况，包括单独或联合使用疾病修饰抗风湿药物（DMARDs）和肿瘤坏死因子抑制剂（TNFi），并按非甾体抗炎药（NSAID）的使用情况进行分层。我们使用条件逻辑回归评估治疗与 THA/TKA 风险的关系，并进行了混杂因素调整。
在 16748 名 AS 成年患者中，有 444 例 THA/TKA 病例和 1613 名匹配对照。在 34512 名 PsA 成年患者中，有 1003 例病例和 3793 名对照。治疗类别与 THA/TKA 的调整比值比（OR）范围为 0.60 至 1.92；然而，均无统计学意义。在几项敏感性分析中，结果同样为零。
在 AS 或 PsA 患者中，NSAIDs、DMARDs 或 TNFi 的任何联合治疗方案都不能降低 THA/TKA 的发生几率。鉴于当前美国 AS 和 PsA 成年患者的使用模式，这些医学疗法似乎与较少的终末期外周关节损伤无关。
